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Medicare Advantage Fight Gets Real - Health Care Edge

Medicare Advantage Fight Gets Real - Health Care Edge

By Sam Baker, Sophie Novack and Clara Ritger


MEDICARE ADVANTAGE RATES EXPECTED TODAY: Insurance companies have already mounted an aggressive preemptive campaign against possible Medicare Advantage cuts. We'll likely find out today whether it worked. CMS is expected to release next year's proposed Medicare Advantage rates this afternoon, and so far the conventional wisdom is to expect a cut, despite pressure from insurers and bipartisan pushback from Capitol Hill.

Top Health Care News

PUBLIC SECTOR CUTS PART-TIME SHIFTS TO DUCK INSURANCE LAW: Employees who work at least 30 hours per week must be offered health insurance, otherwise employers pay a penalty. In the public sector, employers are adopting policies, laws and regulations to make sure workers remain under that threshold. (Robert Pear, New York Times)

MORE THAN 20 CHARGED IN FEDERAL CRACKDOWN ON D.C. MEDICAID FRAUD: Prosecutors say the schemes cheated taxpayers out of tens of millions of dollars. (Matt Zapotosky, Washington Post)


ANOTHER OBAMACARE STATE EXCHANGE DIRECTOR RESIGNS: Nevada Health Link's Jon Hager announced his resignation amid frustration with the state's online web portal. One in three state exchange directors--HI, MD, MN, NV, OR--has resigned.


ARKANSAS MEDICAID PLAN IN LIMBO AFTER ANOTHER FAILED VOTE: The Senate voted 27-8 Thursday to pass the compromise plan to renew funding for the state's version of Medicaid expansion another year, but the bill is stalled after failing for a third time in the House, on a 72-25 vote. (Sophie Novack, National Journal)

  • The House will vote again on the bill Friday, and members say they think the necessary 75 votes will eventually be there to pass the legislation. (David Ramsey, Arkansas Times)

VIRGINIA LEGISLATURE SPLIT OVER MEDICAID EXPANSION: The state's Republican-controlled House voted against Medicaid expansion Thursday, while the Democratically controlled Senate voted in favor of the expanded coverage. (Michael Laris and Laura Vozzella, Washington Post)


OVER 12,000 CONGRESSIONAL STAFFERS HAVE ENROLLED COVERAGE THROUGH OBAMACARE: "The congressional total represents 70 percent of the private insurance plans purchased so far in the District and 98 percent of the enrollment on the city's small-business exchange." (J.D. Harrison, Washington Post)

KENTUCKY GOV. LAUNCHES PROGRAM TO IMPROVE HEALTH: Democratic Gov. Steve Beshear, lauded for successfully implementing the ACA in Kentucky, launched a program Thursday to address specific health issues of Kentuckians that builds off the health care law's expanded coverage. (Tom Loftus and Laura Ungar, Courier-Journal)


HOW OBAMA FUMBLED HEALTHCARE.GOV: "Part of the problem, obviously, stemmed from the president's failure to communicate clearly and honestly. But much of it resulted from his flawed management style. Despite being advised to do so, Obama refused to compensate for his lack of management experience by hiring business leaders who had started or run large organizations with complex information technology (IT) systems. He also failed to take into account the normal bureaucratic imperative that keeps bad news from being transmitted up the chain of command. It's too early to know whether problems with the ACA will turn out to be bumps in the road or an enduring indictment of the Obama presidency. But they do offer some uninspiring insights into the culture of the administration and present an object lesson in how flaws in a president's operating style can have terrible consequences for public policy." (Jonathan Alter, Foreign Affairs)

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BUSTED STATE WEBSITES HAVEN'T CAUGHT UP TO HEALTHCARE.GOV: Congressional Republicans are calling for probes of the failures of three blue states--Oregon, Maryland and Massachusetts--which were awarded more than $500 million since 2010 to build health insurance exchanges. (John Tozzi, Bloomberg Businessweek)

CALIFORNIA'S OBAMACARE ENROLLMENT WEBSITE GOES DOWN: has performed better than until now. (Chad Terhune, Los Angeles Times)


THE UNDERLYING CONDITION: INCREASING DIVERSITY IN CLINICAL TRIALS: African Americans are 12 percent of the U.S. population. They make up 5 percent of patients in clinical trials. The numbers are worse for Hispanics; though they make up 16 percent of the population, they represent 1 percent of clinical trial participants. (John Castellani, National Journal)

STATES COMBAT ALARMING DRUG OVERDOSE DEATHS: "Good Samaritan" laws in 17 states and D.C. extend limited immunity to drug users who seek help for someone who has overdosed. (Michael Ollove, Stateline)

E-CIG INDUSTRY ON TENTERHOOKS AHEAD OF U.S. REGULATION: Some analysts believe e-cigarettes will eventually overtake the $80 billion per year tobacco business. (Toni Clarke, Reuters)


ONLINE DOCTOR RATINGS ABOUT AS USEFUL AS THOSE FOR RESTAURANTS: That doctor may be punctual, but accurate assessments of the quality of care are hard to come by. (Scott Hensley, National Public Radio)

Happening Today

CMS EXPECTED TO RELEASE 2015 MEDICARE ADVANTAGE PAYMENT RATES: The Centers for Medicare and Medicaid Services is expected to release the much-anticipated 2015 payment rates for Medicare Advantage by the close of business.

NATIONAL GOVERNOR'S ASSOCIATION WINTER MEETING: State leaders gather in the nation's capital through Monday, with a portion of the Sunday agenda devoted to health care and drug abuse in the states.


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Health Care Edge is one of my top resources."

Meghan, Associate Specialist

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